Pressure ulcer

From Libre Pathology
Jump to: navigation, search

Pressure ulcer, also known as decubitus ulcer (as it often arises from lying down, i.e. being decubitus, a long time), is a relatively common ditzel.

Ulcers overlying the ischial tuberosity (ischial ulcers) are pressure ulcers.

General

  • Common, esp. in spina bifida,[1] individuals with spinal cord injuries.[2]

Etiology:

Gross

Typical locations:

  • Ischial tuberosity.
  • Sacrum.[5]

Microscopic

Features:

DDx:

Sign out

SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH ACANTHOSIS, HYPERKERATOSIS, PARAKERATOSIS, AND CHRONIC 
  ACTIVE INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH PSEUDOEPITHELIOMATOUS HYPERPLASIA AND CHRONIC ACTIVE 
  INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
LESION ("LEFT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES.
- NEGATIVE FOR MALIGNANCY.
LESION ("RIGHT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN WITH EPIDERMAL HYPERPLASIA, AND DERMAL AND SUBCUTANEOUS TISSUE WITH
  CHRONIC INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
LESION ("SACRAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES, MICROABSCESS
  AND GRANULATION TISSUE.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show skin with acanthosis, hypergranulosis, compact hyperkeratosis and focal full thickness loss of the epidermis, associated with a mixed inflammatory infiltrate. The dermis has reactive fibroblasts with moderate grey cytoplasm, nuclear enlargement and round small nucleoli. Fibroblast nuclei have regular nuclear membranes and a bland chromatin pattern. Small clusters of neutrophils are present.

There is no epidermal nuclear atypia. Mitotic activity is not apparent.

References

  1. Nthumba, PM. (2010). "Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients.". World J Surg Oncol 8: 108. doi:10.1186/1477-7819-8-108. PMID 21129225.
  2. Schessel, ES.; Ger, R.; Oddsen, R. (Feb 2012). "The costs and outcomes of treating a deep pressure ulcer in a patient with quadriplegia .". Ostomy Wound Manage 58 (2): 41-6. PMID 22316632.
  3. Olesen, CG.; de Zee, M.; Rasmussen, J. (Jun 2010). "Missing links in pressure ulcer research--an interdisciplinary overview.". J Appl Physiol 108 (6): 1458-64. doi:10.1152/japplphysiol.01006.2009. PMID 20299616.
  4. Hamanami, K.; Tokuhiro, A.; Inoue, H. (Feb 2004). "Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.". Acta Med Okayama 58 (1): 37-44. PMID 15157010.
  5. Beldon, P. (Dec 2008). "Problems encountered managing pressure ulceration of the sacrum.". Br J Community Nurs 13 (12): S6, S8, 10 passim. PMID 19060829.
  6. Zayour, M.; Lazova, R. (Apr 2011). "Pseudoepitheliomatous hyperplasia: a review.". Am J Dermatopathol 33 (2): 112-22; quiz 123-6. doi:10.1097/DAD.0b013e3181fcfb47. PMID 21399447.
  7. Simmons, MA.; Edwards, JM.; Nigam, A. (Dec 2000). "Marjolin's ulcer presenting in the neck.". J Laryngol Otol 114 (12): 980-2. PMID 11177375.

See also